One Doctor's Opinion

Lyn is a participant in New Mexico's DD Waiver program for the intellectually disabled.  The program places many requirements upon the care providers beyond training and certification.  There are many procedures they are required to follow.  For example, they are required to keep all medication in a lock box.  They have to keep daily logs of the participant's activities.  They even have to follow a specific procedure to administer medication and document if the medication was taken or refused.  The care providers actually have to go through more procedural steps and documentation than that required of foster parents.  (I'm a foster parent who can safely make that comparison.)

Any time a participant visits a doctor, the State's policy requires that a particular form is completed and signed by the attending physician.  Mom forgot this form when she took Lyn to the neurologist earlier this month.  So, the next day, she ran it by his office along with a self-addressed stamped envelope.  He completed the form, signed and mailed it back to Mom.  The report has now been included in the monthly log which will be turned into the State.

The form essentially asks why the physician saw the Waiver participant, what was the diagnosis and course of treatment.  On the form, the doctor states the reason for the visit was memory loss.  For his diagnosis, he lists

• Static Encephalopathy with mild-moderate mental retardation
• History seizure as teen
• Mood d.o. with anxiety  (?)
• Dementia vs Pseudodementia

Please note that the question mark is his.  This is an interesting development because it seems to be a bit of a change from their first visit.  On that day, the doctor listed the following medical codes on Lyn's exit sheet.

• 300.4
• 348.30 
• V77.99

Mom has worked for doctors' and psychologists' offices for over 20 years.  She has handled their billing and insurance issues.  As a result, she's familiar with the codes used when filing insurance claims and looked these up.

They are:

• 300.4 - Dysthymic Disorder (depression)
• 348.30 - Encephalopathy - includes deginerative diseases of the brain
• V77.99 - other & unspecified indocrine, nutritional, metabolic & immunity disorders

When the doctor met with my sister, he made it clear that he didn't believe she has dementia because of her age.  He also suggested that she needed psychiatric help for anxiety.  When they left the office that day, he had not read through any of the notes Mom provided him and, based on what he wrote on her exit sheet, it appeared that he had just decided she was anxious and depressed.

Now, this new form seems to indicate, to me at least, that while he's not 100% convinced that she's got dementia, he may be a little more open to the possibility.  His question mark next to the "Mood disorder with anxiety" is part of what is leading me to think he's not as convinced that she's depressed as he was at that first meeting.  The last bullet, Dementia vs. Pseudodementia (symptoms of dementia brought on by depression), also seems like he's now considering the possibility that she's not depressed.

This is just my reading of his notes.  I, of course, may be wrong.